Provider Demographics
NPI:1477171809
Name:GHARRITT, ANDREA (MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GHARRITT
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HARRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RDN, LDN
Mailing Address - Street 1:6820 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2430
Mailing Address - Country:US
Mailing Address - Phone:920-639-1152
Mailing Address - Fax:
Practice Address - Street 1:6820 5TH AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2430
Practice Address - Country:US
Practice Address - Phone:920-639-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered